ANTICOAGULATION IN ATRIAL FIBRILLATION IN ELDERLY PATIENTS: BALANCE BETWEEN THROMBOTIC RISK AND HEMORRHAGIC RISK

Abstract

Atrial fibrillation (AF), the most common arrhythmia in the elderly, is directly related to the increased risk of thromboembolic complications, such as stroke. Anticoagulant therapy, although essential for prevention, requires a careful analysis between protection against thrombotic events and the potential for bleeding, especially in patients with frailty, multiple comorbidities, and use of several medications. This study, based on a systematic review of the literature on the SciELO and PubMed platforms (articles published between 2014 and 2020), highlights the importance of risk stratification tools, such as the CHA₂DS₂-VASc and HAS-BLED scores, to guide anticoagulation in older adults with AF. Direct oral anticoagulants (DOACs) are safe alternatives to warfarin, with a significant reduction in intracranial hemorrhages (30-50%) and less need for laboratory monitoring. In cases of renal impairment, dose adjustments and regular follow-up are essential, while warfarin is restricted to specific situations, such as mechanical valve prostheses. Older adults with a history of falls or previous bleeding benefit from individualized approaches, combining pharmacological and non-pharmacological interventions, such as cardiovascular risk factor control and trauma prevention. It is concluded that anticoagulation, when properly personalized according to the clinical and functional profile of the patient, presents a favorable balance between risks and benefits, reducing morbidity and mortality. The integration of multidisciplinary strategies and continuing education are essential to optimize adherence and therapeutic safety in this population.